Corona-Norco Family YMCA 1331 River Road Corona, CA 92880 Phone: (951) 736-9622 Fax: (951) 736-6759 EMPLOYMENT APPLICATION THE CORONA-NORCO FAMILY YMCA IS AN EQUAL OPPORTUNITY EMPLOYER PERSONAL INFORMATION: (Please Print) Are you 18 years of age or older? Date of Application: Name (Last, first, middle initial) Street Address City and State Zip Code Home Telephone Number Mobile/Cell Telephone E-mail Address How were you referred to our facility? (Please be specific) Employment Authorization If hired, you will be asked to provide documentation that verifies your legal right to work in the United States. If you are unable to provide acceptable documentation the Association cannot employ you. Can you provide such documentation? Have you ever been convicted of a felony? If yes, please explain. Conviction does not automatically exclude an applicant from consideration for employment. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered. POSITION INFORMATION: (Please Print) Position Desired Starting Salary Desired Available to work (check all that apply) Full Time Part Time Seasonal or Temporary Work What hours and days of the week are you available for work? If hired, on what date can you begin work? Describe any training or special experience related to the position for which you are applying: Why do you want to work for the YMCA? (Please be specific) Revised October 2015 1
EDUCATION School or Institution (Please Print) Institution Name Location (City and State) Number of Years Completed High School State Diploma or Degree Earned Jr. College or Trade School College or University Certificates or Other Are there any other experiences, skills or qualifications that would especially fit you for work with the YMCA? (ECE credits, First Aid CPR certification, etc.) EMPLOYMENT RECORD (Start with your present or most recent employment and include periods of U.S. Military Service) From: To: From: To: From: To: From: To: Revised October 2015 2
PROFESSIONAL REFERENCES List three persons who have knowledge of your work performance within the last 3 years (Please Print) 1. 2. 3. First and Last Name Company Street Address, City, State, Zip Code Work Telephone Number Number of Years Acquainted PERSONAL REFERENCES List below three persons who are former employers or friends 1. (Please Print) First and Last Name Street Address, City, State, Zip Code Telephone Number Number of Years Acquainted 2. 3. The following pages request information for specific positions. You should only answer the questions in the section(s), which are applicable to the positions(s) for which you are applying. For example: Section 1 Section 2 Section 3 Section 4 Section 5 Child Care Applicants Preschool Teacher, School-Age Teacher, Preschool Teacher s Aide, School-Age Teacher s Aide, Lead Teacher Preschool, Lead Teacher School-Age, Site Supervisor. Driver Applicants Van Driver, Youth Bus Driver Clerical/General Office Applicants Front Lobby Receptionist, Administrative Assistant, Accounting Clerk, Office Manager Aquatic Applicants Lifeguard, Swim Instructor Physical Education Applicants Fitness Instructor, Aerobics Instructor, Gymnastics Instructor If you have questions regarding which sections(s) to complete, please ask a Corona-Norco Family YMCA staff person. Revised October 2015 3
SECTION 1 Child Care Applicants 1. What particular habits and/or mannerisms cause you irritation in dealing with children or adults? 2. What positive experiences are you expecting to have working with children and/or adults at the Corona-Norco Family YMCA? 3. What are your goals and philosophies with respect to child care and child development? 4. What qualities in yourself do you feel would contribute to the overall success of our child care program? 5. In what ways do you feel children can benefit from being enrolled in a child care experience? 6. List all the activities for which you are qualified to instruct (i.e., sports, crafts, etc.) A B C G H I SECTION 2 Driver Applicants California Driver s License information: Class: PS Endorsement: Yes No Expiration Date: California Special Driver Youth Bus Certificate: Yes No Expiration Date: Medical Examiner s Certificate: Yes No Expiration Date: Driver applicants are required to provide a current Driver License/ID Card Information (H6 Report) available through the California Department of Motor Vehicles. Are you willing to do so? Yes No List traffic convictions in the past three years: (Attach a separate sheet of paper, if additional space needed) Date: City,State: Description of Conviction: Have you ever been denied a license, permit or privilege to operate a motor vehicle? If YES please explain: Do you possess a current First Aid/CPR Certificate: Yes No Expiration Date: Revised October 2015 4
SECTION 3 Clerical/General Office Applicants Do you possess general computer skills? Yes No Are you experienced with Internet Use? Yes No Are you experienced in Microsoft Word? Yes No Skill Level: Some Knowledge Solid Working Knowledge Advanced Knowledge Are you experienced in Microsoft Excel? Yes No Skill Level: Some Knowledge Solid Working Knowledge Advanced Knowledge State any other computer programs, i.e. QuickBooks, Power Point, etc. with which you have working knowledge: What is your typing speed? Can your operate 10-key by touch? Yes No State all office equipment and machines of which you have working knowledge: SECTION 4 Aquatic Applicants Please list Aquatic Red Cross, YMCA and Lifeguard Certifications: A. Expiration Date: B. Expiration Date: C. Expiration Date: Have you ever worked/volunteered as a Lifeguard? Yes No If yes, please complete the following: Location: Dates: From: To: Have you ever instructed swimming? Yes No If yes, please complete the following: Location: Dates: From: To: What age group do you prefer teaching and why? Revised October 2015 5
SECTION 5 Physical Education Applicants Please list all related certifications: 1. Expiration Date: 2. Expiration Date: 3. Expiration Date: Have you ever instructed a group/class in an area for which are certified? Yes No If yes, please complete the following: Location: Dates: From: To: Please Read Carefully Before Signing This Application I hereby certify that all information contained in this application (and on my resume and any attachments to this form) is true and correct to the best of my knowledge. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I understand that nothing contained in the application or conveyed during any interview, which may be granted or during my employment, if hired, is intended to create an employment contract. I further understand that employment is at-will. Either the employee or the employer may terminate employment at any time with or without cause and with or without notice. I understand and agree my employment may be subject to satisfactory responses to background and reference checks the YMCA, at the YMCA s discretion, may determine it needs to make, and I waive any objection to the YMCA making any such checks. Applicant s Signature Date Revised October 2015 6